Governments and other organizations around the world are exploring creating "vaccine passports": digital credentials that prove a person has been inoculated against the novel coronavirus. But some experts say such passports could exacerbate inequities and threaten users' privacy.

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The push for vaccine passports

According to Politico, vaccine passports are already being developed and tested out around the world.

And overseas, the European Union (EU) last week introduced the "Green Certificate," a digital or paper vaccine passport that would allow every resident in the EU to prove they've either been vaccinated, recently received a negative Covid-19 test, or recovered from Covid-19.

As for the United States, different areas are adopting different approaches. New York, for example, is testing an "Excelsior Pass" that will allow theaters and large venues like Madison Square Garden to reopen, while Hawaii is developing a passport that would allow visitors to bypass the state's 10-day quarantine requirement.

But airline industry leaders and others are calling on the federal government to take a more active role in overseeing the production of vaccine passports in the United States, Healthcare Dive reports. "We need some leadership from the federal government," Marcus PLescia, CMO of Association of State and Territorial Health Officials, said, adding that a quick, unchecked deployment of vaccine passports could result in different systems that don't work together.

Tori Barnes, EVP of public affairs and policy at the U.S. Travel Association, added, "There's a role for the U.S. government to set standards," especially to ensure the passports are "interoperable."

The Biden administration, meanwhile, has started to engage with technology firms on how such credentialing might work, including whether pharmacies might be able to provide the required data, Politico reports. The administration has also started talks with 25 federal agencies about the passports, including asking whether they'd be interested in their own employees using them.

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"We're working with our federal partners on understanding the landscape and best evaluating what the considerations are there," Micky Tripathi, head of the Office of the National Coordinator, said.

However, the Biden administration has stated that the government itself shouldn't issue the passports or store the necessary information. "The right way is that it should be private, the data should be secure, the access to it should be free, it should be available digitally and in paper, and in multiple languages, and it should be open source," Andy Slavitt, a White House Covid-19 adviser, said.

Why some experts are concerned that passports could worsen inequities—or threaten privacy

However, some public health experts and bioethicists have raised concerns that vaccine passports could exacerbate inequities that already have led some populations to suffer disproportionately from the pandemic.

The Electronic Frontier Foundation, for instance, has said using digital vaccine passports that are smartphone-based for people to access public places would result in a two-tiered system that keeps people without access to cellphones or testing out of work, stores, or schools.

Nicole Errett, a public health expert at the University of Washington, echoed those concerns. "If vaccines become a passport to doing different things, we're going to see the communities that have been already hardest hit by Covid being left behind," she said.

Further, communities less likely to have ready access to vaccines or vaccine passports—including minority populations and those with fewer socioeconomic resources—could face discrimination, Halima Begum, who runs Runnymede Trust, a British racial equity organization, said.

"We already saw, with the coronavirus regulations with lockdown, disproportionate amounts of stops and searches for young minority men," she said, referring to searches and fines issued by police. "So you can see who is potentially likelier to be grabbed up for not carrying the passport and therefore be denied access."

And some stakeholders have voiced concerns about lawmakers trying to require proof of vaccination to renter society, noting that such an approach could spur backlash—and worsen vaccine hesitancy and distrust, the New York Times reports. "[T]he specter of a mandate" might "erode the ability to appeal to people" to get vaccinated on the basis of informed consent and increase the risk of "politicized misinformation," Renée DiResta, a disinformation expert at the Stanford Internet Observatory, said.

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There's also the issue of developing countries not having access to vaccines yet, Errett said. "If we are opening up the world only to people from high-income countries, we are creating a lot of inequity," she pointed out. "We're cutting people off from resources and from connections that keep economies and communities thriving."

Experts also raised privacy concerns, as requiring people to store test results and vaccination records digitally could create vulnerabilities to data breaches, Axios reports—particularly given America's decentralized medical system, which makes it difficult to easily access their health care information.

"I can pretty much 100% guarantee that fraud is going to occur," Jane Lee, a trust and safety architect at Sift, said. "We will have a lot of bad actors where they pretend to offer a service that will provide some sort of vaccination passport, but it's really a phishing campaign."

Separately, Deanne Kasim, executive director at Change Healthcare, which is working with Microsoft and Salesforce on standards and technology for passports, said, "We wanted data to reside on patients' phone" rather than a database, so patients can control their data.

Do the pros outweigh the cons?

Stakeholders have also cited several practical concerns with widely implementing a vaccine passport system.

Medical experts, for instance, still don't fully know how effective vaccines are at stopping transmission or how long immunity lasts, especially as new coronavirus variants are emerging that make vaccines less effective, according to.

"The utility of a vaccine passport is only as good as the evidence of how long the immunity lasts," David Salisbury, an associate fellow at Chatham House, said. "You could find yourself with a stamp in your passport that lasts longer than the antibodies in your blood."

Moreover, vaccine passport developers are working on an increasingly tight timeframe, Axios reports. The more people are vaccinated, according to Axios, the less value there will be in establishing a system that distinguishes between the vaccinated and unvaccinated (Tahir, Politico, 3/17; Deighton, Wall Street Journal, 3/16; Lawler, Axios, 3/18; Walsh, Axios, 3/6; Fisher, New York Times, 3/2; Pifer, Healthcare Dive, 3/11).